Fire Safety & Staffing
For the most part, nursing home administrations would like to be able to make the determination about how many staff are needed for a given situation on their own without government oversight. This has always been the American way. The employer gets the freedom to decide about staffing, taking all the risk and getting all the reward for innovations that reduce man hours.
Rather than relying on the state to determine by formula or otherwise how many people to employ for a given shift or a given number of patients, the Administration has usually been able to set the number taking into account the needs of the patients and the abilities of the staff hired. So long as everyone agrees that patient safety and well-being come first, the system works well. It is when administrators start speculating about patient safety and the number of staff necessary that the notion of government oversight starts to have some real appeal.
A good case study in what happens when a facility speculates about how many staff are needed for a home can be found in what happened at Anderson Guest House in Anderson, Missouri. In late November of 2006 a fire broke out at the Anderson Guest House at 1 a.m. when there were only two staff members on duty in the facility. Two staff, 33 patients, one staff member for every sixteen elderly and mentally disabled residents.
Investigators later learned the home was operated by a convicted felon. The two employees who were on duty at the time of the fire were a husband and wife. One died of smoke inhalation after going back into the blaze to search for residents. The other employee was treated for smoke inhalation at a local hospital. Nine residents perished in the fire, and twenty-three required medical treatment of one variety or another.
Like many of these smaller group-home ventures, the staffing was inadequate to insure the safety of the residents, and ten people paid for that staffing mistake with their lives. Although other factors may also have played a role in the tragedy (including the lack of sprinklers) the main contributor to the deaths was a lack of sufficient personnel to evacuate the residents.
A skilled nursing facility must have sufficient personnel to evacuate the residents in the event of a fire. More importantly, practice and fire drills that focus on shifts other than the day shift are vital to ensure that everyone from aides to nursing professionals know what to do and how to do it. Resident census and room information must be updated every day. A copy of the updated census and room assignments should be placed on a fire response clipboard at the nursing desk to ensure that in the event of a fire a roll-call can be conducted to ensure that all residents were safely evacuated. Ambulatory residents should know where to go and what to do in a fire, and should participate in drills at night as well as during the day.
Rally points outside the building may look differently at night, and may be confusing. Patients with special needs (dementia, Alzheimers, etc.) and who are ambulatory may need special assistance evacuating in a fire.
There is no substitute for practice and attention to detail in fire safety. And the core of fire safety requires that sufficient staff be on hand to evacuate sleepy and confused residents in the event of a fire.